On-admission serum uric acid predicts outcomes after acute myocardial infarction: systematic review and meta-analysis of prognostic studies

Abstract

AimTo evaluate the prognostic value of serum uric acid (SUA) in acute myocardial infarction (AMI) patients.MethodsSystematic review and random-effects meta-analysis of prognostic studies assessing AMI outcomes (death, major adverse cardiac events, MACE) in relation to on-admission SUA.ResultsNine studies (7655 patients) were identified, 6 in the ST-segment elevation AMI patients treated with invasive revascularization and three in mixed AMI type cohorts with variable reperfusion strategies. “High” SUA (vs “low,” different cut-offs) was univariately associated with higher short-term mortality (8 studies/6805 patients; odds ratio [OR], 3.24; 95% confidence interval [CI], 2.47-4.27) and incidence of MACE (7/6467; OR, 2.46; 95% CI, 1.84-3.27, moderate heterogeneity, mild bias), and with higher medium-term mortality (5/5194; OR, 2.69; 95% CI, 2.00-3.62, moderate heterogeneity, mild bias) and MACE (4/4299; OR, 1.93; 95% CI, 1.36-2.74, high heterogeneity, mild bias). It was independently associated with a higher short-term (4/3625; OR, 2.26, 95% CI, 1.85-2.77) and medium/long-term (3/2683; hazard ratio [HR], 1.30; 95% CI 1.01-1.68, moderate heterogeneity, mild bias) occurrence of poor outcomes (death/MACE). As a continuous variable (by 50 μmol/L), higher SUA was also independently associated with poorer medium/long-term outcomes (4/3533; HR, 1.19; 95% CI, 1.03-1.37, high heterogeneity, mild bias). All individual study effects (unadjusted or adjusted) were in the same direction, but differed in size. Heterogeneity was mainly due to the included AMI type and/or definition of MACE. All bias-corrected pooled effects remained significant.ConclusionBased on the available data, high(er) on-admission SUA independently predicts worse short-term and medium/long-term outcomes after AMI. However, the number of data are modest and additional prospective studies are warranted.

Gender differences in the association between serum uric acid and prognosis in patients with acute coronary syndrome

“…Kaya et al showed that a high UA level on admission was independently associated with MACE in patients with ST-elevation myocardial infarction who undergo PCI [17]. The meta-analysis by Trkulja et al reported a significant association between UA level and short-and long-term outcomes after acute myocardial infarction [24]. Some studies have demonstrated that there is a significant relationship between UA level and post-primary PCI myocardial perfusion grade [22,25].…”

The association between serum uric acid level and heart failure and mortality in the early period of ST-elevation acute myocardial infarction

“…[2][3][4] Furthermore, UA was found to be a strong marker of cardiovascular disease including acute and chronic heart disease, heart failure and stroke. [5][6][7][8] Acute myocardial infarction (AMI) remains one of the most significant causes of death worldwide, and patients with AMI have a higher mortality rate during the first month following an event, especially during in-hospital stays. [9] Hence, in this study, we aimed to evaluate the relationship between serum UA levels and cardiovascular events and the incidence of mortality during in-hospital period in patients with STelevated acute myocardial infarction (STEMI).…”

Serum Uric Acid Its Correlation With Outcomes of Myocardial Infarction

“…Similar studies conducted in Croatia by Vladimir Trkulj et al 16 and Ersan Tatli et al 17 concluded that high serum uric acid at admission independently predicts worse short-term and medium/long-term outcomes after AMI, poor outcomes in MACE and associated with higher in-hospital mortality and thirty-day mortality and poor long-term survival after AMI.…”